Table 3.
Published guidelines on VR for OAT.
| Guideline and Brief Description |
|---|
| EAA Guideline Management of OAT [65] |
| - Recommended: VR in young males with progressive testicular failure and/or seminal deterioration |
| - Can be discussed: VR for infertile couples reporting OAT associated with palpable varicocoele |
| - Only monitor: cases with subclinical varicocele |
| AUA/ASRMDiagnosis and Treatment of Infertility in Men: Guideline part I and part II [66,67] |
| - Consider: VR among men attempting to conceive, who have palpable varicocele(s), infertility, abnormal semen parameters, except for azoospermic men |
| - Not recommended: VR in men with nonpalpable varicoceles detected solely by imaging |
| - Absence of definitive evidence: VR prior to ART for clinical varicocele in NOA patients |
| ASRM/SMRU Report on Varicocele and Infertility: A Committee Opinion(2014) [45] |
| - Consider: VR when most/all of these criteria are met: 1) varicocele is palpable on physical examination of scrotum; 2) couple has known infertility; 3) female partner has normal fertility or potentially treatable cause of infertility, and time to conception is no concern; 4) male partner has abnormal semen parameters |
| - Consider: VR in adolescents/young males with varicoceles + reduced ipsilateral testicular volume |
| - Not indicated: VR for patients with either normal semen quality, isolated teratozoospermia, or subclinical varicocele |
| EAU Guidelines on Sexual and Reproductive Health(2023) [51] |
| - Recommended in adolescents: VR for those with ipsilateral reduction in testicular volume + evidence of progressive testicular dysfunction |
| - Recommended in infertile men: VR for clinical varicocele + abnormal semen parameters + otherwise unexplained infertility in couple where female partner has good ovarian reserve to improve fertility rates |
| - Consider: VR for men with raised DNA fragmentation with otherwise unexplained infertility, or who have had failed ARTs, including RPL, failure of embryogenesis, and implantation |
| - Not indicated: VR for infertile men with normal semen analysis and men with sub-clinical varicocele |
ASRM: American Society for Reproductive Medicine; AUA: American Urological Association; EAA: European Academy of Andrology; EAU: European Association of Urology; SMRU: Society for Male Reproduction and Urology; ART: Assisted Reproductive Technology; FSH: Follicle stimulating hormone; IVF: In vitro fertilization; NOA: non-obstructive azoospermia; OAT: Oligoasthenoteratozoospermia; RPL: Recurrent Pregnancy Loss; VR: varicocele repair.